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The Current State of Epicutaneous Immunotherapy for Food Allergy: a Comprehensive Review

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Abstract

The food allergy epidemic of recent years has led to the search for safe and effective methods of immunotherapy for foods. Studies of epicutaneous immunotherapy (EPIT) in mice have shown promising safety and efficacy data. Murine models have also identified probable mechanisms for the development of tolerance to food allergens, including the induction of regulatory T cells. Clinical data is lacking, but relatively small and early studies among peanut and cow’s milk allergic subjects suggest that EPIT has an excellent safety profile, particularly compared to other methods of specific allergen immunotherapy. Efficacy data are also promising for peanut allergy, among younger patients (ages 4–11 years of age), suggesting that a majority of young patients will experience an increase in reaction threshold with therapy. The goal of this therapy is the protection from accidental exposures to a known food allergen. Additional clinical data is needed to prove efficacy and further demonstrate the safety profile of EPIT for food allergy, prior to approval by the Food and Drug Administration.

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Abbreviations

EPIT:

epicutaneous immunotherapy

OIT:

oral immunotherapy

SLIT:

sublingual immunotherapy

SU:

sustained unresponsiveness

OFC:

oral food challenge

DBPC:

double-blind, placebo-controlled

TAAEs:

treatment associated adverse events

CTD:

cumulative tolerated dose

SCD:

successfully consumed dose

EDS:

epicutaneous delivery system

DCs:

dendritic cells

LN:

lymph node

EoE:

eosinophilic esophagitis

VEDS:

Viaskin® epicutaneous delivery system

SCIT:

subcutaneous immunotherapy

FDA:

Food and Drug Administration

RCT:

Randomized controlled trial

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Authors and Affiliations

  1. Department of Pediatrics, Division of Allergy and Clinical Immunology, National Jewish Health, 1400 Jackson St, J322, Denver, CO, 80206, USA

    Bruce J. Lanser & Donald Y. M. Leung

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  1. Bruce J. Lanser
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  2. Donald Y. M. Leung
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Correspondence to Bruce J. Lanser.

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Conflict of Interest

BJL and DYML have received research support from DBV Technologies, and participate in CoFAR, funded by NIAID/NIH. BJL has received research support from AImmune Therapeutics, has formerly received a speaker honorarium from Mylan, and served as a consultant to AImmune Therapeutics. DYML is the chair of the AImmune Therapeutics DSMB for phase 3 clinical trials.

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Lanser, B.J., Leung, D.Y.M. The Current State of Epicutaneous Immunotherapy for Food Allergy: a Comprehensive Review. Clinic Rev Allerg Immunol 55, 153–161 (2018). https://doi.org/10.1007/s12016-017-8650-3

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